Surgical ablation can be done as a standalone procedure or in combination with another heart surgery. In developing these new guidelines, the authors assessed the safety of performing surgical ablation for three surgical approaches: primary open atrial operations where the left atrium, or top chamber of the heart, is already being opened, such as mitral valve repair or replacement and/or tricuspid valve repair; primary closed atrial operations when the left atrium would not otherwise be open, such as coronary artery bypass grafting (CABG) and/or aortic valve replacement (AVR) operations; and standalone operations when the only goal is to perform surgical ablation to treat Afib.
The new clinical practice guidelines offer evidence-based recommendations that include:
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Surgical ablation for Afib at the time of concomitant mitral operations to restore cardiac rhythm;
Surgical ablation for Afib at the time of concomitant isolated AVR, isolated CABG, and AVR+CABG operations to restore cardiac rhythm; and
Surgical ablation as a primary standalone procedure to restore cardiac rhythm for symptomatic Afib that is resistant to medication or catheter ablation.
The authors also recommend a multidisciplinary heart team assessment, treatment planning, and long-term follow-up in order to optimize patient outcomes in the treatment of Afib.
"These guidelines may help guide surgeons when faced with a challenging decision on the management of Afib," said Dr. Badhwar. "The guidelines represent an assimilation of the world's literature; they do not supersede the final medical decision of the surgeon. It is important to remember that the ultimate choice of any therapy remains between the patient and their doctor."
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